oklahoma’s employer/employee partnership for insurance coverage (insure oklahoma/o-epic) ...
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Oklahoma’s Employer/Employee Partnership for Insurance Coverage (Insure Oklahoma/O-EPIC)
www.insureoklahoma.org1-888-365-3742
What is Insure Oklahoma?
Provides Premium
Assistance
Targets Low-Income
Uninsured Adults
Dedicated
Funding Source
Employer Sponsored Insurance
(ESI)
Targets Low-Income Uninsured
Adults
Dedicated Funding Source
Individual Plan (IP)
Two Different Strategies
Insure Oklahoma
Provides Premium
Assistance
Targets Low-Income Uninsured
Adults
Dedicated Funding Source
Qualified Employer
99 or fewer employees
Business located in Oklahoma
Offer a Qualified Health Plan
Contribute 25% of employee premium
Must cover hospital, physician, lab, X-ray and pharmacy services
Maximum out-of-pocket $3,000
Maximum office visit co-pay $50
Maximum pharmacy annual deductible $500
Qualified Health Plan
Targets Low-Income Uninsured
Adults
Dedicated Funding Source
Meet income and
program guidelines
Primary must be ages 19
through 64
Contribute 15% of
monthly premium
Qualified Employee
With Employment Allowance
Yearly
Family Size
Single Income Family (one
worker household)
Double Income Family (two
workerhousehold)
1 $ 24,660 $ -
2 $ 32,300 $ 35,180
3 $ 39,940 $ 42,820
4 $ 47,580 $ 50,460
5 $55,220 $ 58,100
6 $ 62,860 $ 65,740
Income Levels
Qualified Spouses
Qualified Children
Who Qualifies?
Qualified College Students
Provides Premium
Assistance
Targets Low-Income Uninsured
Adults
Dedicated Funding Source
Qualified Spouses
99 or fewer employees
If 23 or less hours may work for any size employer
No Medicaid or Medicare
Provides Premium
Assistance
Targets Low-Income Uninsured
Adults
Dedicated Funding Source
Qualified Children
Ages 0-18
Household income 186-200% of FPL
Change form or new application
Legal guardian must be approved with IO
Provides Premium
Assistance
Targets Low-Income Uninsured
Adults
Dedicated Funding Source
Qualified College Students
Ages 19 through 22
Must attend an accredited college full time in Oklahoma
Must supply FAFSA
Must supply school schedule
Example of Contributions
DEPENDENT(S)
EMPLOYEE
Final Rate
Schedule
Final Rate
Schedule
EFT Form EFT Form
Staff Listing
Application/Contract
Employer Enrollment Process
PIN Letter
Insure Oklahoma
application
Report all income/
household information
Social Security Numbers
Employee Enrollment Process
Health plan
invoice to TPA
Electronic deposit to employer
Employer forwards
total amount to the carrier
Employer Payments
Renewal
•Tied to employer
•Change employers
•Change health plans/event
•Automatic renewal every twelve months
•Change health plans
Employer Employee
Individual Plan (IP)
The Individual Plan is a health coverage option for qualified
Oklahomans
Example of IP Medical Card
123456789
Example--New Medical Card
123456789
Working adults without access
to Insure Oklahoma ESI
Temporarily unemployed
adults
Working adults with a
disability
Who Qualifies?
Individual Plan (IP)
Meet income and
program guidelines
Primary must be ages 19
through 64
Premiums based on
sliding scale of income
IP Qualifications
Income Levels
With Employment Allowance
Yearly
Family Size
Single Income Family (one
worker household)
Double Income Family(two worker
household)
1 $ 24,660 $ -
2 $ 32,300 $ 35,180
3 $ 39,940 $ 42,820
4 $ 47,580 $ 50,460
5 $ 55,220 $ 58,100
6 $ 62,860 $ 65,740
Income Levels
Annual Income
Family Size
Self Employed* & Unemployment Income (Gross)
1 $21,780
2 $29,420
3 $37,060
4 $44,700
5 $52,340
6 $59,980
* For Self-employed households we require your most recent tax return, including all schedules (Schedule C, Schedule F, etc). If you are apply as self-employed, please send all of your recent tax documents. For more information please call 1-888-365-3742 or refer to our income fact sheet found at www.insureoklahoma.org
Qualified Spouses
Qualified Children
Who Qualifies Continued?
Qualified College Students
Individual Plan (IP)
Provides Premium
Assistance
Targets Low-Income Uninsured
Adults
Dedicated Funding Source
Qualified Spouses
99 or fewer employees
If 23 or less hours may work for any size employer
No Medicaid or Medicare
Provides Premium
Assistance
Targets Low-Income Uninsured
Adults
Dedicated Funding Source
Qualified Children
Ages 0-18
Household income 186-200% of FPL
Change form or new application
Legal guardian must be approved with IO
Provides Premium
Assistance
Targets Low-Income Uninsured
Adults
Dedicated Funding Source
Qualified College Students
Ages 19 through 22
Must attend an accredited college full time in Oklahoma
Must supply FAFSA
Must supply school schedule
Premiums
• Monthly premium is based on annual household income
• Sliding scale– Premiums range– $0-$119.00
• No more than 4%
Office Visits - $10
Hospital Inpatient - $50 / Outpatient $25
ER - $30 (waived if admitted)
Pharmacy - $5 Generic / $10 Brand
Co-payments
Some limitations
$15,000 DME
annually
$1 million lifetime
maximum
Some services are not covered
Please refer to the member handbook for a complete listing
Questions
For more information:• Visit our web site at:
www.insureoklahoma.org • Call the helpline at:
1-888-365-3742
Oklahoma’s Employer/Employee Partnership for Insurance Coverage (O-EPIC)
www.insureoklahoma.org1-888-365-3742